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Maine rates for HCPCS 12004

Simple Rpr Scalp/Neck/Ax/Genit/Trunk 7.6-12.5cm

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$58.71 / $294.86 / $523.05
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$58.71 / $102.71 / $209.12
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$77.69 / $127.04 / $202.69
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$79.92 / $145.66 / $254.82
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$90.27 / $160.22 / $276.89
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$94.29 / $293.35 / $447.61
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$58.71 / $102.70 / $176.85
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$127.54 / $175.78 / $267.38